DESCRIPTION: (Applicant's Description) The proposed study focuses on prevention of smoking initiation among youth enrollees in two managed care organizations. Parents and children have a direct, ongoing relationship with the health care system, and there may be synergy in establishing a partnership between the parent and the health care provider in efforts to prevent smoking initiation. The study aims are to: (1) Conduct a randomized trial to evaluate the impact of a smoking prevention intervention package for parents and children (ages 10-12) that is provided through two large managed care organizations. The intervention includes: (a) mailed parental smoking prevention kit; (b) outreach follow-up phone call(s) to the parent by a health educator; (c) mailed child's smoking prevention kit; (d) provider endorsement and supportive message for parents and children via cues placed in medical chart of the parents and children; and (e) booster newsletter mailing and health educator call at one year. This intervention will be compared to a usual care control group in a two-arm study. The primary endpoint will be susceptibility to smoking at a 24-month followup. Experimentation with cigarettes, and monthly smoking will also be evaluated as secondary outcomes. (2) Conduct a prospective, longitudinal analysis of the smoking onset process. Building from a social-learning theoretical perspective, we will: (a) Assess the correlation between parent and child regarding tobacco attitudes, beliefs, behavior, and marketing exposure, cross-sectionally and over time; (b) Identify predictors of susceptibility, experimentation with smoking, and monthly smoking, and (c) Identify child and parent factors which modify the effect of the intervention. The methodological aims of the study are to: (1) Identify a population-based sample of families with children ages 10-1 2 (N=l0,000); (2) Randomize consenting families (N=5000) to intervention or usual care; (3) Identify a subsample of 375 families in the intervention and control groups (total N = 750) to serve as a longitudinal assessment subcohort. Conduct telephone health behavior surveys with randomly selected parent (in families with 2 parents enrolled in GHC & KPNW) and index child; (4) Conduct 6, 12 and 24 month follow-up surveys of parents and children in the assessment subcohorts and (5) Conduct follow-up surveys with children in all study families 24 months post-randomization.